Flashcards in USMLE Renal Deck (62)
What HF drug will result in gynecomastia?
Spironolactone - similar structure to steroid
What drug can be added onto a HF regimen to improve survival?
How does IL-2 suppress tumours?
Enhancing T cell and NK cell activity
What part of the kidney reabsorbs the most water?
People with upper motor neuron lesions have what kind of bladder?
Where does uric acid precipitate in the renal tubules and why?
Collecting ducts, b/c of low urine pH
How are particles filtered in the glomeruli?
By size (fenestrated capillaries) and by charge (heparan sulfate in the BM)
How do you calculate renal clearance?
Cx = Ux*V/Px
How do you calculate filtered load?
Filtered load = GFR x Px
How do you calculate excreted load?
Excreted load = Ux * V
What is the Potter Sequence?
Renal failure in utero
If one baby has a dysplastic kidney, what's the risk of subsequent children having one as well?
Relatively low, not inherited.
If a newborn has the Potter sequence, what condition do you suspect?
If a newborn has signs and sx of portal HTN, what condition do you think of?
If patient presents with fam hx of renal failure and death from brain hemorrhage/renal failure, what condition do you think of?
How do you differentiate prerenal from renal acute kidney injury?
BUN:creatinine ratio goes up in prerenal, down in renal.
How does the BUN:creatinine ratio change in early and late postrenal kidney injury?
Rises then falls as tubules get damaged.
If a patient with AKI has oxalate crystals in their urine, what do you think of?
Ethylene glycol poisoning leading to nephrotoxic (vs ischemic) ATN
Patient with fever, rash, hematuria, and eosinophils on urine. Dx?
Acute Interstitial Nephritis
Minimal change disease is associated with what other disease?
What are the risk factors for FSGS?
Heroin use, sickle cell disease, HIV infxn
FSGS is the most common cause of nephrotic syndrome in what kinds of people?
Black and Hispanic
Membranous is the most common cause of nephrotic syndrome in what kinds of people?
Minimal change disease is the most common cause of nephrotic syndrome in what kinds of people?
What kind of nephrotic and nephritic syndromes do SLE patients present with?
Membranous nephropathy, Diffuse proliferative glomerulonephritis
Granular immunofluorescence points towards what kind of nephropathy?
Membranous nephropathy b/c it signifies immune complex deposition
What does tram track appearance on PAS stain point towards?
What is Type I membranoproliferative glomerulonephritis associated with?
What is Type II membranoproliferative glomerulonephritis associated with?
C3 nephritic factor, which stabilizes C3 convertase, decreases C3 levels
What is the first change in the kidneys in diabetes?
Non enzymatic glycosylation of the GBM
What feature in the kidneys is pathognomonic for diabetes?
Kimmelstiel Wilson lesions
What defines nephritogenic strains of group A strep?
M protein virulence factor
Subepithelial hump in EM. Dx?
Periorbital edema, cola-coloured urine, HTN. Dx?
In RPGN, what are the crescents on biopsy made up of?
Fibrin and macrophages
Patient presents with hematuria, hemoptysis, and have RPGN with sinusitis. Dx?
Wegener's granulomatosis (w/ +ve c-ANCA)
Patient presents with hematuria, hemoptysis, and have RPGN. Dx?
Patient presents with isolated hematuria, sensory hearing loss and eye problems with positive fam hx. Dx?
What kind of stone typically develops from an ammonium Mg phosphate stone?
What is important to exclude with hypercalciuria?
What does being on dialysis in end stage renal failure increase the risk of?
What are angiomyolipomas associated with?
What is the triad associated with RCC?
What paraneoplastic syndromes are associated with RCC?
Epo (2ndary polycythemia)
What do you think of if you see a left-sided varicocele?
Pathogenesis of RCC involves loss of what gene?
VHL on chromosome 3
What is the key component of Wilms tumour?
What are the risk factors for urothelial carcinoma?
Smoking (Naphthylamine and polycyclic aromatic HCs)
Long term cyclophosphamide and phenacetin
Flat urothelial carcinomas are associated with...
Early p53 mutations
Middle Eastern male presents with painless hematuria. Dx?
Squamous cell carcinoma of the bladder secondary to schistosoma infection
What kind of cancer with urachal remnants?
Bladder adenocarcinoma on the dome of the bladder
Patients with angiomyolipomas also have what findings?
Brain hamartomas and ash-leaf skin patches as a result of tuberous sclerosis
Calcium kidney stones typically lead to what Ca levels in blood and urine?
What are important factors to check in the differential of metabolic alkalosis?
Volume status and urine chloride
What drug should you check for before giving ACEi and why?
Thiaizide or loop diuretics b/c of potential first dose hTN
How do you calculate net filtration pressure?
(Hydrostatic of Glomerulus - Hydrostatic of Bowman) - (Oncotic of Glomerulus - Oncotic of Bowman)
A man treated for sinusitis with ampicillin later presents with oliguria, rash, fever. What does he have?
What cells are Epo released from?
Interstitial cells of peritubular capillary bed
Why does the BUN rise in prerenal AKI?
Because kidneys reabsorb H2O, Na, and BUN to raise volume
How do you prevent Ca stones from precipitating?
By adding citrate
What does ANCA stand for?
Anti neutrophil cytoplasmic antibodies